Uterine Prolapse

Question 1

What is Uterine prolapse?

Answer 1

Loss of anatomical support for the uterus

Descent of one of the pelvic organs resulting in protrusion on the vaginal walls

Question 2

RF for uterine prolapse?

Answer 2

Increasing age
Multiparity, vaginal deliveries
Obesity
Spina bifida
Previous prolapse surgery
Genetic factors
White

Question 3

Features of uterine prolapse

Answer 3

Vaginal protrusion/ bulge
Sensation of vaginal pressure
Urinary incontinence
Constipation

Question 4

DDx for uterine prolapse?

Answer 4

Cervical elongation
Vaginal cyst

Question 5

What is uterine prolapse?

Answer 5

Loss of anatomical support for the uterus

Question 6

Investigations for uterine prolapse?

Answer 6

Assessment of post-void residual urine volume- women with advanced prolapse often have voiding difficulties–> may result in urinary retention, recurrent UTI and damage to renal parenchyma (rare)

Urinalysis- higher risk of UTIs

Question 7

Treatment for asymptomatic uterine prolapse?

Answer 7

Observation +/- pelvic floor muscle rehabilitation

Question 8

Treatment for symptomatic uterine prolapse?

Answer 8

1st line: ring pessary
2nd line lreconstructive surgery or native tissue repair
Consider: anterior/posterior vaginal repair
Consider: sacro spinous suspension, burch urethropexy or mid-urethral sling

Question 9

Complications of uterine prolapse, including complications after repair?

Answer 9

Dyspareunia after posterior repair
Post repair urinary incontinence
Faecal incontinence after posterior repair
Vaginal erosion
Urinary retention
Post-repair recurrent prolapse

Question 10

What is a rectocoele?

Answer 10

• caused by defect in posterior vaginal wall
• Allows rectum to prolapse forward into the vagina

Question 11

Issues associated with rectocoele?

Answer 11

• Constipation
• Women can develop faecal loading in the part that has prolapsed–> this results in signifcant constipation, urinary retention and palpable lumb

Question 12

What is a cystocele?

Answer 12

• Defect in anterior vaginal wall
• Allows bladder to prolapse backwards into the vagina

Question 13

What is a urthrocele?

Answer 13

Prolapse of urethra into the vagina
Prolapse of both bladder and urethra is called a cystourethrocele

Question 14

What do we use to grade the severity of uterine prolapse?

Answer 14

The Pelvic organ prolapse quantification system. (POP-Q)

Question 15

What are some conservative measures for uterine prolapse?

Answer 15

• Offered to women with mild symptoms, do not tolerate pessaries or are not suitable for surgery
• Physiotherapy
• Weight loss
• Lifestyle changes for associated stress incontinence
• Treatment of related symptoms e.g. anticholinergic for stress incontinence
• Vaginal oestrogen cream

Question 16

Adv and disadv of using pessaries?

Answer 16

Adv- no surgical intervention
Disadv- have to be changed every 4-6 months, can cause ulceration/irritation etc ( co-prescribe oestrogen cream as helps protect the vaginal walls)

Question 17

Complications of surgery for pelvic organ prolapse?

Answer 17

• Pain
• Bleeding
• DVT risk
• Anaethetic risk
• Damage to bladder or bowel
• Recurrence of prolapse
• Altered experience of sex

Question 18

Complications of mesh repairs for pelvic organ prolapse?

Answer 18

Chronic pain
Altered sensation
Dyspareunia
Abnormal bleeding
Urinary or bowel problems

Question 19

OSCE

Pt asks you:

Am i able to change my own pessary or do I need to come into the hospital everytime?

Answer 19

• We will put you in touch with a women’s health physiotherapist or specialist nurse, they will teach you how to remove and insert the pessary
• We recommend a yearly review to see how you are getting on and check up, and replacement pessaries